Can you have a natural birth and use Nitrous Oxide?

Nitrous Oxide Twin Cities

I’ve had this blog post tumbling through my head most of the week, and so it needs to be written so my brain can start processing other things…like different blog posts.

So, I don’t know if you know this, but we’re really lucky to have some of the things we do in the Twin Cities. Within the next week or so, almost all of the the hospitals in the area will have nitrous oxide as an option (Although it looks like the wait will be a number of months for St. John’s and Woodwinds), and I’m pretty certain that all of the birth centers have it available. Do you know how rare that is in the US? I know it’s popped up a couple of other places, but not in the widespread availability we have here. Ever since it first showed up as an option, I’ve been including it in our discussions of pain medication and interventions in classes, discussing the pros and cons. It is a medication, after all. But…..

Philosophically to ME anyway, using nitrous just doesn’t seem to be on the same plane as narcotics or epidurals. It doesn’t have any meaningful long term effects on mom or baby within a minute or two of not using the nitrous. It doesn’t involve restrictions on labor beyond the mom having to be the only one touching the mask and she must administer it herself. And the analgesic effects are only felt with active use, meaning a mom must actively breathe it in. The risks are low, the benefits are high, a mom can use it off and on throughout her labor as needed. It doesn’t work for everyone, though, and not everyone likes it.

You know what it reminds me of? Hydrotherapy, i.e. soaking in a tub or using a shower. The ease of use is about the same, the risks are low for both, you’ll still find providers actively against the practice. (ha!)

What worries me is that, as more people use nitrous for their labors and births, that this option– which was first embraced locally by birth center midwives– becomes another thing for “natural birth” proponents to place into the “bad” category. First of all, I’m not sure on any given day what people are labeling as “natural” (vaginal?), but the process of making decisions for birth isn’t a binary one. Things aren’t either good or bad. Pitocin isn’t inherently bad. Epidurals aren’t inherently bad. You can’t make decisions about birth that way. Birth and the process of making decisions IS a continuum. It’s always best to start from the place of the normal biological process of birth and then build in an understanding of where interventions, including pain management options, fall on that line. However, I’m concerned that parents aren’t choosing to take birth classes that help them understand the full scope and use, opting instead to take classes with little to no actual content, but endorsed by the hospital, or to take a class that does lean heavily on labeling certain interventions “bad”.

Using nitrous oxide is on one end of the pain management spectrum. Epidurals are on the other end. Both totally have their place in this world. As nitrous becomes an option everywhere and more families are informed about their pain management options, I’ll be interested to see how it ends up being labeled in the good/bad universe of birth options. For now, I’m going to very loudly and very firmly hold it as an option that may work for some people, that is fast acting, and has very few side effects when used properly…just like hydrotherapy.

That’s what I have for today. Thanks for listening.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Guest Post: What is Postpartum Anxiety?

Today’s guest post comes from Sarah Letischuh, who sees patients in my building and is part of The BabyLove Alliance, Ltd. Anxiety is something I have struggled with all my life, with a bout after the birth of my son being one of the worst times I had anxiety. Sarah works with kids as well as adults and moms who are struggling with Perinatal Mood Disorders. One of the things I love about Sarah is how kind she is to everyone. She also has a lot of experience dealing with trauma, a must when we’re talking about pregnancy and birth. She’s truly wonderful. Check out her recent post on Postpartum Anxiety.
-Veronica

In my personal experience as a mom-to-be, I often heard about postpartum depression.    My doctors screened for it.  My friends experienced it.  It was talked about in the news.   On the other hand, I don’t remember hearing about postpartum anxiety until I began to learn more about perinatal mental health, in my role as a therapist.

6% of pregnant women develop anxiety.

10% of women develop anxiety during the postpartum period.

It is certainly normal to experience some anxiety during pregnancy and after the birth of a child.   Anxiety is a natural response to change and we know that being pregnant means lots of changes are occurring and will continue to occur.   The symptoms of perinatal  anxiety (anxiety during pregnancy or the postpartum period) are more intense and last longer than fleeting worries.

Symptoms of perinatal anxiety may include:

  • Constant worry
  • Racing thoughts
  • Difficulty sleeping
  • Change in appetite (eating too much or not enough)
  • Intense fear or expecting something bad to happen
  • Difficulty relaxing
  • Physical symptoms such as headaches, stomachaches or feeling shaky

If you believe you or a loved one are experiencing symptoms of perinatal anxiety please know you are not alone, even if no one else is talking about it.   These symptoms can be very overwhelming.  You may feel like no one understands what you are experiencing, but don’t let that stop you from reaching out for help.

A trained mental health provider can help you assess your symptoms and determine the best treatment option in order to help you obtain some relief from your anxiety.

I am available to meet with new parents in the South Metro to assess and treat symptoms of perinatal anxiety.   Please click here to read more about the counseling services I offer for new or expecting parents.   I can also be reached at 952-457-2322 or sarah@sarahleitschuhcounseling.com.

If you are from outside of Minnesota, I suggest visiting the Postpartum Support International  website to locate support in your area.
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Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Primary Cesarean Rate By Group: Thoughts

I promised some thoughts on my blog post with the medical group rates last week. I was really interested in how many people actually clicked through to read the long as heck report! That’s awesome! But in some discussions online, a few things came up that need clarification.

First of all, this report is put out by Minnesota Community Measurement, an non-profit. I just find it and try to boil down the information in a way that’s more manageable. A lot of people were also wondering why some groups, namely midwife groups and family med groups, weren’t on the list. Here’s the exact methodology, as found on page 175:

This measure assesses the percentage of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section between July 1, 2014 and June 30, 2015 patients who had a C-section delivery. Any clinic that is part of a medical group in which the medical group has providers who perform cesarean deliveries were eligible to report data for this measure.

The statewide rate for Maternity Care: Primary C-Section Rate was 22 percent (a lower rate is better for this measure). Table 26 displays the details of this statewide rate. Figure 12 shows the average rate for this measure over time.

In maternity care, patients often seek care from multiple providers across locations within a medical group. Additionally, there are some providers who provide maternity care but may not perform c-sections, and patients who require a c-section are referred to a physician who does. Previous clinic level reporting of the maternity care measure did not include the deliveries performed by providers at a site without providers who performed c-sections, and as a result, rates for the state and at the medical group level had the potential to be artificially elevated. The maternity care measure is most appropriately calculated and reported at the medical group level in order to account for these considerations.

A few other people bemoaned the fact that we don’t have info on VBAC rates versus repeat cesareans. I agree. Given that, out of their whole existence, this is only the third report that MN Community Measurement has put out that has any Cesarean information, we’re really lucky to have the info we have. And really,  maternity care transparency is just a problem in Minnesota– we don’t really have any. We have a teeny bit, and I share as much as I can find.

OK, but my thoughts on the numbers:

For their volume, Park Nicollet had a really impressive primary rate of 20.1%, though it was up slightly from last year’s 19.2%. Since being bought by HealthPartners, which had a rate of 21.7% in this report, I do worry about the Park Nicollet number creeping up. Oh, and if you remember back to the post on costs of birth, there’s a major difference in price between Methodist and Regions.

In groups that had drops, I’m really impressed by John A Haugen Associates at 16.2% ( down from 21.2%), Multicare Associates at 19.3% (previously at 29.5%!), Adefris and Toppin Women’s Specialists down to 21.9% ( from 27%), and the biggest group on the list was Allina Health Clinics who was at 21.6%, down from last year’s 25.8%.

Hennepin County Medical Center, which had high marks in the 2012 report from MNCM, had an even worse showing than last year, going from 24.7% in the 2015 report after having a primary cesarean rate of 19.1% in 2014’s report. I’m curious to see how this will be reflected in the 2015 cesarean rates.

Speaking of 2015 Cesarean rates, that info isn’t available, but I’m going to throw caution to the wind and make a few guesses. I think we’ll see an increase in rates at Woodwinds, a slight increase at Methodist and a larger increase at Maple Grove (largely as a result of the high primary rates from OBGYN West and Western OBGYN), increases at Ridges, Southdale, and Regions. I’m going to predict a drop in the overall censarean rate at Abbot Northwestern, St. Joe’s, and North Memorial. I don’t think there will be many changes at St. Francis, St. John’s, or United. As far as the Unity and Mercy…who knows. Now, we’ll have to see if I’m right.

What do you find interesting about all of this? I’d love to know your thoughts!

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

2015 Twin Cities Medical Group Primary Cesarean Rates

I’m a big nerd when it comes to birth data. Maybe you’ve noticed. So when new information becomes available, it’s like Christmas to me. Yesterday, I figured out that MN Community Measurement had finally released their 2015 Health Care Quality Report. For the second year in a row, they reported Primary Cesarean rates by Medical Group.

So, some good news. The State’s rate of primary cesarean dropped from 22.2% to 21.9%. After a decade of rapid increases in cesarean rates, this is just another measure that shows we’re going in the right direction. Whee!

OK, time for the real stuff. From highest rates to lowest, here’s what the report has for Medical Groups. For comparison, I put the rate from 2014’s report in parentheses.

  1. Allina Health Specialties- 34.7% (27.9%)
  2. Comprehensive Healthcare for Women- 33.0% (30.5%)
  3. Western OBGYN- 29.2% (26.1%)
  4. OBGYN West-27.9% (24.1%)
  5. Women’s Health Consultants- 27.0% (24.9%)
  6. Metropolitan OBGYN- 26.0% (29.5%)
  7. Partners OBGYN- 25.2% (27%)
  8. Clinic Sofia- 25.1% (25.1%)
  9.  Obestetrics and Gynecology Associates- 24.8% (21.9%)
  10. Hennepin County Medical Center Clinics -24.7% (19.1%)
  11. Fairview Health Services- 23.5% (24.8%)
  12. Adefris and Toppin Women’s Specialists- 21.9% (27%)
  13. Healthpartners Clinics- 21.7% (n/a)
  14. Allina Health Clinics- 21.6% (25.8%)
  15. Southdale OBGyn Consultants- 21.5% (21.6%)
  16. Park Nicollet Health Services- 20.1% (19.2%)
  17. North Clinic- 19.6% (24.4%)
  18. Multicare Associates- 19.3% (29.5%)
  19. U of M Physicians-18.4% (17.3%)
  20. Oakdale OBGYN- 16.3% (18.7%)
  21. John A Haugen Associates- 16.2% (21.2%)
  22. Hudson Physicians- Minnesota Healthcare Network- 14.9% (11.8%)
  23. AALFA Family Clinic- 4.7% (13.0%)

You can read the full report for 2015 here.

Coming up in the next post, I’ll share my thoughts on some of these numbers. In the meantime, enjoy!

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.